Top 10 challenges and opportunities in Health Care
1. Costs and transparency. Implementing strategies and tactics to address growth of medical and pharmaceutical costs and impacts to access and quality of care.
2. Consumer experience. Understanding, addressing, and assuring that all consumer interactions and outcomes are easy, convenient, timely, streamlined, and cohesive so that health fits naturally into the “life flow” of every individual’s, family’s and community’s daily activities.
3. Delivery system transformation. Operationalizing and scaling coordination and delivery system transformation of medical and non-medical services via partnerships and collaborations between healthcare and community-based organizations to overcome barriers including social determinants of health to effect better outcomes.
4. Data and analytics. Leveraging advanced analytics and new sources of disparate, non-standard, unstructured, highly variable data (history, labs, Rx, sensors, mHealth, IoT, Socioeconomic, geographic, genomic, demographic, lifestyle behaviors) to improve health outcomes, reduce administrative burdens, and support transition from volume to value and facilitate individual/provider/payer effectiveness.
5. Interoperability/consumer data access. Integrating and improving the exchange of member, payer, patient, provider data, and workflows to bring value of aggregated data and systems (EHR’s, HIE’s, financial, admin, and clinical data, etc.) on a near real-time and cost-effective basis to all stakeholders equitably.
6. Holistic individual health. Identifying, addressing, and improving the member/patient’s overall medical, lifestyle/behavioral, socioeconomic, cultural, financial, educational, geographic, and environmental well-being for a frictionless and connected healthcare experience.
7. Next-generation payment models. Developing and integrating technical and operational infrastructure and programs for a more collaborative and equitable approach to manage costs, sharing risk and enhanced quality outcomes in the transition from volume to value (bundled payment, episodes of care, shared savings, risk-sharing, etc.).
8. Accessible points of care. Telehealth, mHealth, wearables, digital devices, retail clinics, home-based care, micro-hospitals; and acceptance of these and other initiatives moving care closer to home and office.
9. Healthcare policy. Dealing with repeal/replace/modification of current healthcare policy, regulations, political uncertainty/antagonism and lack of a disciplined regulatory process. Medicare-for-All, single payer, Medicare/Medicaid buy-in, block grants, surprise billing, provider directories, association health plans, and short-term policies, FHIR standards, and other mandates.
10. Privacy/security. Staying ahead of cybersecurity threats on the privacy of consumer and other healthcare information to enhance consumer trust in sharing data. Staying current with changing landscape of federal and state privacy laws.
“We are seeing more change in the 2020 HCEG Top 10 than we have seen in recent years and for good reason. HCEG member organizations express that the demand for, and pace of change and innovation is accelerating as healthcare has moved to center stage in the national debate. It shouldn’t be surprising that costs and transparency are at the top of the list along with the consumer experience and delivery system transformation,” says Ferris W. Taylor, Executive Director of HCEG. “Data, analytics, technology, and interoperability are still ongoing challenges and opportunities. At the same time, executives need to be cautious, as individual health, consumer access, privacy, and security are on-going challenges that also need to remain as priorities.”
Turning challenges into opportunities
Reducing costs means lower revenue for providers and almost all of the players in healthcare––except for consumers and payers, says Mark Nathan, CEO and founder of Zipari, a health insurtech company. So while there are many incentives to keep healthcare costs high, if consumers are provided with the information they need to improve their health and drive down their personal costs, then we could see consumers en mass making decisions that drive down costs across the industry, he adds.
“Predicting cost in the traditional health insurance environment is shockingly complex,” Nathan says. “The most advanced payers can simulate claims and predict the cost of procedures. However, as you layer in full episodes of care, such as knee surgery, it becomes much harder to accurately predict the patient's total out-of-pocket cost. Bundled value-based payments start to make cost transparency a little easier to predict, but most plans still have a way to go to get to that type of offering.”
The greatest opportunity to drive down health costs––for payers, consumers, and system-wide––is with the payer-consumer relationship, he says. “Payers have the information consumers need to make better decisions about their health and finances––if plans can build positive and trusted relationships with their members. Once a payer proves it can make valuable and trusted recommendations, the consumer can make the decisions that will not only lead to better health outcomes but also to reduced cost of care.”
